NEW YORK, July 19, 2001 - Patients with lung cancer live longer if they have surgery at hospitals with experience, according to a study conducted by researchers at Memorial Sloan-Kettering Cancer Center.
The study, published in the July 19 issue of the New England Journal of Medicine, found that patients with lung cancer who undergo lung resection surgery at a hospital that performs larger numbers of the procedures are more likely to survive and have less complications following surgery.
"Our study suggests that there is a significant difference in the quality of care received by patients having surgery for lung cancer," said Peter B. Bach, MD, first author of the study and a pulmonary physician and epidemiologist at Memorial Sloan-Kettering.
"Patients who went to the highest volume hospitals had an 11 percent increased survival rate compared to those patients who went to the lowest volume hospitals. Since approximately 1 in 5 patients diagnosed with lung cancer will have lung resection surgery, it is imperative to identify the possible reasons for the disparity and address it.”
Researchers looked at a population based sample of 2118 patients aged 65 years old or older, who lived in one of 10 study areas covered in the Surveillance, Epidemiology and End Results (SEER) Program and who had been diagnosed with stage I, II, or IIIA non-small cell lung cancer between 1985-1996.
Survival rates were examined at 30 days, two years and five years. The average five-year survival for these patients was 38 percent, but patients who went to the highest volume hospitals had a 44 percent five-year survival rate while patients who had the same procedure at the lowest volume hospitals had only a 33 percent five-year survival rate. Complication rates were also twice as high in the lowest volume hospitals, compared to the highest volume hospitals.
“Unfortunately, most hospitals in the U.S. that perform this surgery are low volume hospitals,” added Dr. Bach. Of the 76 hospitals in the study 34 performed only 1 to 8 surgeries a year, and 14 performed 9 to 14 surgeries a year. In contrast, only 2 of the hospitals were high volume providers, performing five to ten times as many surgeries (67 to 100 per year).
"The study confirms growing evidence that the quality of cancer surgery is related to the experience of the hospital,” said Colin Begg, Ph.D., chairman of the Department of Epidemiology and Biostatistics at Memorial Sloan-Kettering and the paper's senior author. “Major complications of surgery are less likely in hospitals that treat larger numbers of cancer patients, and this translates into lower mortality rates.”
Lung cancer is the leading cause of cancer death for men and women in the United States. In the year 2001, it is estimated that there will be 169,500 new cases diagnosed and 157,400 deaths.
Memorial Sloan-Kettering Cancer Center is the world's oldest and largest institution devoted to prevention, patient care, research and education in cancer. Our scientists and clinicians generate innovative approaches to better understand, diagnose and treat cancer. Our specialists are leaders in biomedical research and in translating the latest research to advance the standard of cancer care worldwide.
Journal
New England Journal of Medicine